Objective To compare the difference of MRI characteristics of pilomyxoid astrocytomas (PMA)and pilocytic astrocy-tomas (PA)in hypothalamus/optic chiasma region.Methods The MR images and clinical materials of 20 PMAs and 20 PAs proved by pathology were reviewed retrospectively.Imaging characteristics and clinical materials were analyzed,including age,gender, size,the signal characteristics of the tumor,growth,enhancement pattern,hydrocephalus and leptomeningeal dissemination.Results There were statistically significant differences in streaky low signal intensity among the high intensity of T2 WI and leptomeningeal dissemination between PMA and PA (P <0.05).However,no statistically significant differences were found in the other character-istics and clinical materials between the two types of tumors.Conclusion PMA and PA in hypothalamus/optic chiasma region are difficult to make differential diagnosis.The streaky low signal intensity among the high intensity of T2 WI and more frequent lepto-meningeal dissemination are helpful differential features of PMA as compared to PA.

Objective To investigate the influence of the national volume-based procurement(NVBP)policy on the economy and use structure of anti-infective drugs in a general 3-A hospital,and to provide a reference for the standardization of clinical application management and policy implementation.Methods The price,defined daily doses(DDDs),average defined daily cost(DDDc),actual cost saving,substitution rate of selected drugs(SRSD)and avoidance rate of alternative drugs(ARAD)of anti-infective drugs before and after the implementation of 1-7 collection NVBP policy were analysed.Results The NVBP policy led to a＞70％reduction in the price of 70.73％of the hospital's target drugs,69.70％of the DDDs increased,81.82％of the DDDc decreased and 63.64％showed the relationship of"volume increase and price decrease".The average SRSD was 84.49％in the first cycle and 95.94％in the second cycle.The average actual cost saving in the first cycle was 474 100 yuan,with an average saving rate of 407.60％,and in the second cycle was 803 100 yuan,with an average saving rate of 1 257.04％,showing an increasing trend year by year.The consumption of alternative drugs increased by 53.85％in the first cycle and 66.67％in the second cycle,with the highest annual increase of 555.63％,and the average of 74.65％.Conclusion After the implementation of NVBP policy,selected drugs mainly replaced unselected drugs,and the cost of anti-infection treatment was greatly reduced.However,it was necessary to strengthen the control of alternative drugs,standardize the management of clinical application,carry out clinical comprehensive evaluation of selected drugs and real world research.

Objective:To evaluate the predictive value of regional cerebral oxygen saturation (rScO 2) for the occurrence of sepsis-associated encephalopathy (SAE). Methods:The data of 94 patients with sepsis admitted to the intensive care unit of Nanjing Drum Tower Hospital from September 2019 to June 2021 were collected. The patients were divided into SAE group and non-SAE group according to the evaluation results of daily intensive care unit confusion assessment method (CAM-ICU) during ICU treatment. The general data such as age and gender of the patients, rScO 2 on 1, 2, 3, 5, and 7 days of ICU admission, and prognostics were recorded. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of rScO 2 on SAE during ICU stay. Results:All 94 patients were enrolled in the analysis, of whom 59.6% (56/94) were male, and the mean age was (50.1±15.1) years old; the incidence of SAE was 31.9% (30/94). The levels of rScO 2 within first 3 days of ICU admission in the SAE group were significantly lower than those in the non-SAE group (1 day: 0.601±0.107 vs. 0.675±0.069, 2 days: 0.592±0.090 vs. 0.642±0.129, 3 days: 0.662±0.109 vs. 0.683±0.091, all P < 0.05). However, there was no significant difference in rScO 2 level on the 5th or the 7th day between the SAE and non-SAE groups (5 days: 0.636±0.065 vs. 0.662±0.080, 7 days: 0.662±0.088 vs. 0.690±0.077, both P > 0.05). ROC curve analysis showed that 1-day rScO 2 had the greatest predictive value for SAE [1 day: area under the ROC curve (AUC) = 0.77, 95% confidence interval (95% CI) was 0.65-0.89, P < 0.01; 2 days: AUC = 0.60, 95% CI was 0.48-0.72, P > 0.05; 3 days: AUC = 0.55, 95% CI was 0.41-0.68, P > 0.05]; with 1-day rScO 2 = 0.640 as the diagnostic threshold, the sensitivity was 73.4%, the specificity was 80.0%. Compared with the non-SAE group, the length of ICU stay and hospital stay in the SAE group were significantly longer [length of ICU stay (days): 13.6±7.1 vs. 9.0±4.3, length of hospital stay (days): 20.1±8.0 vs. 15.8±6.1, both P < 0.05], but the ICU mortality between the two groups was not statistically different. Conclusions:The incidence of SAE is relatively high in ICU patients, and the occurrence of SAE can be predicted by monitoring rScO 2. The rScO 2 value on the first day of ICU admission is closely related to the occurrence of SAE, and may be the target of sepsis resuscitation to guide the treatment and improve the long-term prognosis.